[Tracheobronchial stenting in patients with non-resectable tumors complicated by airway stenosis]. / Endoskopicheskoe stentirovanie trakheobronkhial'nogo dereva u patsientov so stenoziruyushchei nerezektabel'noi opukhol'yu.

OBJECTIVE: To study the results and efficiency of tracheobronchial stenting in patients with unresectable tumors complicated by stenosis of central airways. MATERIAL AND METHODS: We analyzed the results of tracheobronchial stenting in 23 patients with unresectable tumors complicated by stenosis of central airways between 2016 and 2021. RESULTS: Technical and clinical success rate was 100%. No intraoperative complications were noted. Dyspnea regressed in all patients in early postoperative period. Moreover, there was objective improvement in lung ventilation with increase in lung capacity (from 2.1±0.4 to 2.7±0.5 l; p<0.05), forced expiratory volume (from 1.2±0.5 to 1.8±0.4 l; p<0.05), partial pressure of oxygen in arterial blood (from 47±7.4 to 85±6.3 mm Hg; p<0.05) and arterial oxygen saturation (from 86.1±8.2 to 93.1±5.1%; p<0.05). One patient developed massive bleeding due to tumor decay on the 3rd day after surgery. In 2 patients, stent obturation with a «mucus plug¼ was observed after 2-3 postoperative days. In 3 months after surgery, 21.8% of patients had disturbances of external respiration accompanied by mild dyspnea due to granulation tissue growth. Stent migration in 3 months after endoscopic stenting was recorded in 1 patient. Three-month mortality was 26.1%. CONCLUSION: Tracheobronchial stenting is a safe and effective minimally invasive surgical intervention. As a part of palliative care, this procedure improves functional and clinical parameters of pulmonary ventilation and reduces the incidence of complications. Thus, quality of life in patients with unresectable tumors complicated by airway stenosis is improved.

[Silent atrial fibrillation as a risk factor for falls in the elderly.]

Falls increase the risk of injury, disability, and death in the elderly. Atrial fibrillation (AF) is one of the risk factors for falls in old age, however, the relationship between «silent¼ AF and falls has not been investigated. The study included patients (n=131) from 60 years and older who admitted in the City geriatric medical and social center. Previously diagnosed AF was detected in 13,7% (n=18) of the study participants, and «silent¼ AF was detected in 11,5% (n=15). Both forms of AF were associated with a 4-fold increase in the incidence of falls in old age: (95% CI) 4,26 (1,18-15,40) for previously detected AF and 4,56 (1,25-16,66) for «silent¼ AF. AF screening revealed 16,9% (95% CI 6,7-26,8%; p<0,001) more patients at risk of falls. Thus, «silent¼ AF, as well as previously diagnosed, are independent risk factors for falls. Conducting AF screening allows to identify more elderly patients who are at risk of falls.

[Can the pre-dialysis period in stage IV chronic kidney disease be prolonged?] / Mozhno li prodlit' dodializnyi period pri IV stadii khronicheskoi bolezni pochek?

Analysed herein are the results of treating a total of 29 patients presenting with stage IV chronic kidney disease (CKD) induced by ischaemic nephropathy. All patients had renal artery stenosis more than 80%, decreased glomerular filtration rate (GFR) below 30 ml/min/1.73m2 and were regarded by the nephrologists as potential candidates for programmed haemodialysis. After preparation aimed at preventing contrast-induced nephropathy all patients underwent stenting of the stenosed renal arteries. In the early postoperative period, 21 patients were found to have stabilization of the GFR with a tendency to increase. One woman developed acute renal failure requiring renal replacement therapy by means of haemodialysis. During the follow-up period from 1 to 5 years, 26 patients showed no progression of azotemia. CKD changed to stage III in 15 patients (p<0.005). Twenty-three (84%) patients during the follow-up period developed no new cardiovascular events. Hence, performing renal revascularization for renal artery stenosis >80% revealed in patients with stage IV CKD promotes prolongation of the dialysis-free period.

Stimulation of Spermatogenesis and Synthesis of Testosterone by Allotransplantation of Neonatal Testicular Tissue under Tunica Albuginea of Cryptorchid Testis.

The abdominal type of cryptorchism was modeled on random-bred albino rats by replacing both testes from the scrotum into the abdominal cavity for 3 weeks; thereupon they were manipulated into the scrotum. In control rats, no additional surgery was performed. In experimental rats, the testicular tissue obtained from 1-2-day rat pups was transplanted under testicular tunica albuginea. Prior to orchiopexy, the weight of testes decreased by 62.5-64.1%. In 6 month after the surgery, it increased by 36.1% in the control group, whereas in experimental rats the weight of testes elevated by 123.2% and approximated the normal value. Histologically, the control group demonstrated persistent disturbance in spermatogenesis with emptiness of numerous seminiferous tubules where only Sertoli cells could be revealed and with pronounced dystrophic alterations in the spermatogenous epithelium of the partially preserved tubules where spermatogenesis was blocked at the spermatogonial level. In contrast, the transplantation region of the experimental testes exhibited formation of novel mature testicular tissue enclosed by a connective tissue capsule incorporating the seminiferous tubules with differentiated epithelium and with the clusters of Leydig cells in the stroma. In 6 month, spermatogenesis was observed in most seminiferous tubules of the host testicular tissue, which had spermatozoa in the lumens. To the moment of orchiopexy, the blood testosterone decreased by about 2.5-fold. In control group it remained diminished during entire observation period (up to 6 month), while in the experiment group its level normalized completely as early as in 2 month and remained even elevated to the end of observation period.

[Efficacy of carotid endarterectomy in patients with vertebrobasilar insufficiency without significant lesion of vertebral arteries]. / Éffektivnost' karotidnoi éndarteréktomii u bol'nykh s vertebro-baziliarnoi nedostatochnost'iu bez znachimogo porazheniia pozvonochnykh arterii.

The authors examined efficacy of carotid endarterectomy (CEA) in treatment of patients suffering from vertebrobasilar insufficiency (VBI) without significant involvement of the vertebral arteries. The study included a total of 297 patients with VBI and diagnosed as having stenosis of the bifurcation of the carotid arteries amounting to 70% and more, with no significant involvement of the vertebral arteries revealed. All patients underwent CEA: eversion CEA was performed in 226 (76.1%) cases and the classical one in 71 (23.9%) cases. On postoperative day 10, clinical improvement in the form of decreased severity of VBI was observed in 152 (51.2%) patients. One year after surgery, improvement persisted in 135 (45.5%) patients and after 3 years in 125 (42%) patients. Prognostic factors of unsatisfactory clinical outcomes were determined. It was demonstrated that in VBS, CEA is clinically efficient only if the circle of Willis is closed and there is no history of stroke in the vertebrobasilar basin. Besides, the outcome of the operation appeared to have been influenced by such factor as the duration of hypertension and diabetes mellitus. No effect of either cardiac arrhythmia or the technique of CEA on the results of treatment was observed.

[Treatment of resistant arterial hypertension in the remote period after carotid endarterectomy]. / Techenie rezistentnoi arterial'noi gipertenzii v otdalennom periode posle operatsii karotidnoi éndarteréktomii.

The aim of the study was to determine peculiarities of the course of resistant arterial hypertension (AH) in the remote period after performing the operation of carotid endarterectomy in patients presenting with haemodynamically significant (more than 70%) stenosis of the carotid bifurcation. The study included a total of 105 patients. The course of AH was evaluated in the immediate (2-7 days) and remote (3-7 years) periods after the operation of carotid endarterectomy. Ninety-two (87.6%) patients presenting prior to the operation with resistant AH were postoperatively found to have persistent stabilization of arterial pressure and its milder course. A good clinical effect (possibility of reaching the target arterial pressure) in the remote period was noted to preserve in 65.7% of patients. The proportion of patients with grade III AH decreased from 43.8% (prior to operation) to 5.8% in the remote postoperative period (p<0.001). It was also determined that the degree of the antihypertensive effect after the performed operation of carotid endarterectomy depended upon the duration of a previous medical history of arterial hypertension before surgery: the sooner the operation is performed the more pronounced its antihypertensive effect is.

[The choice of surgery in patients with diffuse toxic goiter]. / Vybor ob''ema operatsii u bol'nykh diffuznym toksicheskim zobom (s kommentariem).

AIM: to define clear individual indications for different operations for diffuse toxic goiter by research of immunological markers of thyrotoxicosis recurrence probability. MATERIAL AND METHODS: Long-term results of survey and treatment of 215 patients with diffuse toxic goiter are presented. Patients were divided into 2 groups. The 1st group consisted of 31 patienrs who underwent conventional partial thyroidectomy. Group 2 included 184 patients. They were divided into 2 subgroups depending on type of surgery. Subgroup A included 59 patients after partial thyroidectomy and subgroup B - 125 patients after total thyroidectomy. In group 2 surgery was defined based on only level of antibodies against TSH-receptors. RESULTS: Recurrence incidence was 16 and 0% in groups 1 and 2 respectively. CONCLUSION: In patients with diffuse toxic goiter partial thyroidectomy is possible if normal titer of antibodies against TSH-receptors is present (<1.5 U/l). Total thyroidectomy is advisable in titer ≥1.5 U/l.

[Perioperative use of statins in vascular surgery].

The review is dedicated to studying the effect of perioperative use of statins while performing vascular operations, examining possible aftermaths of statins discontinuation in the perioperative period and discussing safety of perioperative use of statins. Cardiovascular complications constitute the most common cause of perioperative mortality while performing major noncardiac operations. Clinical studies demonstrated a favourable effect of statins on the cardiovascular complications rate in the perioperative period, therefore use of statins for prevention of cardiovascular diseases seems substantiated appropriate. Acting upon the levels of blood serum lipids, statins also influence various signal cellular pathways, exerting anti-inflammatory, antithrombotic and vasodilating effects. Thus, they may be used not only for patients with lipid metabolism impairments. However, currently required are further studies in order to determine optimal dosage, as well as the terms and duration of therapy with statins in the perioperative period.

[Surgical treatment of a patient with occlusion of the main trunk of the renal artery of the solitary kidney].

Presented herein is a clinical case report of successful stagewise surgical treatment of a patient with atherosclerotic occlusion of the main trunk of the renal artery of the single kidney. Clinically, the patient had signs of ischaemic renal disease in the form of pronounced azotemia being characteristic of the terminal stage of renal insufficiency, as well as malignant arterial hypertension. Besides, the patient had previously endured ischaemic stroke in the vertebrobaslar basin. The patient was subjected to stagewise surgical intervention, i.e., stenting of the upper-pole renal artery followed by open operation--prosthetic repair of the left renal artery with a synthetic prosthesis. Three months thereafter, the patient underwent carotid endarterectomy and operation of transposition of the subclavian artery. The postoperative period turned out uneventful. Currently, no progression of azotemia is observed, neither are there any indications for carrying out restorative therapy of the renal function.

[Optimization of surgical tactics in treatment of spontaneous pneumothorax].

299 patients with spontaneous pneumothorax were treated. All patients were divided in two groups. Patients of the first group (n=182) received thoracic puncture and/or drainage. The second group (n=117) has surgery, directed at liquidation of the source of pneumothorax, i.e., they received either atypical lung resection or subtotal parietal pleurectomy. The recurrent pneumothorax was registered in 24 (13.2%) patients of the first group and in 4 (3.4%) patients of the second. Authors state that radical surgical procedure for the spontaneous pneumothorax is an atypical lung resection with parietal pleurectomy. The use of active surgical tactics allows to decrease the number of recurrencies on 9.8%.

Do the results of adrenalectomy in symptomatic arterial hypertension depend on morphological alterations in adrenal glands?

The article deals with surgical treatment of patients presenting with resistant arterial hypertension and detected pathology in the adrenal glands. The authors analysed the outcomes of surgical management of 97 patients with resistant arterial hypertension, also determining the factors contributing to prediction of the antihypertensive effect of adrenalectomy depending on morphological damage to the adrenal glands.

[Endovascular treatment of a female patient with resistant arterial hypertension secondary to a renal artery aneurysm].

Described herein is a successful therapeutic outcome in a female patient presenting with resistant arterial hypertension secondary to a gigantic intraorganic aneurysm of the right renal artery. Treatment consisted of intravascular prosthetic repair of the parenchymatous portion of the renal artery, eventually making itpossible to entirely bypass the aneurysmatic sac and to restore the lumen of the renal artery, followed by normalization of arterial pressure.

[Surgical management of a hypertensive young adult suffering from nonspecific aortoarteritis accompanied by renal arterial lesions].

Presented herein is a successful outcome of stagewise surgical management of a young adult suffering from nonspecific aortoarteritis accompanied renal artery lesions. The patient was subjected to a stagewise intervention consisting of stenting of the renal arteries and an open operation, i.e. bilateral aortorenal bypass grafting performed with the synthetic stent B-Braun.

[Biological aspects of choice of the intestinal segment for the cystoplasty].

Contractile activity of the iliac and sigmoid intestines versus detrusor activity, reabsorption and secretory activity of the iliac and sigmoid intestinal mucosa in contact with urine were studied in 30 rats. It was found that isolated segments of the iliac and sigmoid intestines have spontaneous contractile activity (stronger in the iliac intestine) while bladder segment contracted only in response to electric stimulation. A contraction-stimulating effect of acetylcholine and a relaxing effect of noradrenaline in experiments with the iliac intestine were close to their effects on the detrusor. The sigmoid intestine responded weaker to the above mediators. The iliac mucosa actively reabsorbed urinary urea, creatinin, glucose causing elevation of their concentrations in blood as well as K, Na, Ca, CI, P and secreted protein in urine leading to hypoproteinemia. The sigmoid mucosa showed weaker metabolic activity. The results of the study demonstrate importance of consideration of biological properties of different intestinal regions for choice of a cystoplasty method after cystectomy.

[Is it possible to expand the indications for primary radical operations for perforated gastric and duodenal ulcer?].

A retrospective analysis of 365 completed patient records received by the duty surgical hospital with perforated gastric ulcer and duodenal ulcer. All the patients were operated on urgently. Diagnosis of purulent peritonitis was set 17% of patients, "serous"--47.4%, "seroplastic"- 35.6%. 75.3%, perform suturing of perforated openings, regardless of the form of peritonitis. The remaining 24.7%--interventions that address as a perforation, and the impact on the pathogenesis of peptic ulcer. When radical surgery, which were performed in selected patients even with purulent peritonitis, deaths were reported. And when suturing the ulcer defect lethality was 14.5%. In this group of patients were comparable in age and severity of general condition. It is concluded that that the operations of suturing perforated ulcers were used unnecessarily broad, and the majority of patients admitted to hospital with a perforated stomach ulcer and duodenum may increase the volume of surgical benefit for radical treatment of complications as well as most of peptic ulcer.

Endogenous Na/K-ATPase inhibitors in patients with preeclampsia.

Although preeclampsia (PE) is a major cause of maternal and fetal mortality, its pathogenesis is not fully understood. Digitalis-like cardiotonic steroids (CTS) are believed to be involved in the pathophysiology of PE, as illustrated by clinical observations that DIGIBIND, a digoxin antibody which binds CTS, lowers blood pressure in PE. Recently we reported that plasma levels of marinobufagenin (MBG), a vasoconstrictor CTS, are increased fourfold in patients with severe PE. In the present study, we tested whether anti-MBG, or anti-ouabain antibodies, or DIGIBIND can reverse inhibition of erythrocyte Na/K-ATPase (NKA) from patients with mild PE (blood pressure, 149 +/- 3/93 +/- 3 mm Hg; age, 28 +/- 2 years; gestational age, 37 +/- 1 weeks). Development of PE was associated with twofold rise in plasma MBG levels (1.58 +/- 0.15 vs. 0.80 +/- 0.11 nmol/L; P<0.01). The activity of erythrocyte NKA in 12 patients with PE was lower than in 6 normotensive gestational age-matched subjects (1.56 +/- 0.18 vs. 3.11 +/- 0.16 micromol Pi/ml/hr; P<0.001). In vitro treatment of erythrocytes from PE patients with anti-MBG antibody fully restored the NKA activity (3.26 +/- 0.41 micromol Pi/ml/hr; P<0.01). The effects of DIGIBIND was marginally significant (2.53 +/- 0.32 micromol Pi/ml/hr), while the anti-ouabain antibody was not effective (2.25 +/- 0.25 micromol Pi/ml/hr, P>0.5). The present observations provide evidence for a role for MBG in the pathogenesis of PE, and suggest that antibodies against MBG may be useful in the treatment of this syndrome.

Effect of carotid operations on regression of motor disorders in patients with a history of ischemic stroke.

This paper is concerned with an evaluation of the clinical effect of reconstructions on the brachiocephalic vessels in patients who suffered ischemic stroke. Altogether 143 patients with the above pathology were operated on. Of these, mild hemiparesis was present in 72 patients, moderate hemiparesis in 49, and severe hemiparesis was recognized in 17 subjects. The postoperative lethality accounted for 1.4% (2 subjects). Intraoperative development of repeated stroke was ascertained in three more subjects. The follow up of the operated patients lasted from three months to two years. In the postoperative period, a study was made of the time course of changes in motor pyramidal deficit. The study allowed the conclusion to be drawn that reconstructions on the brachiocephalic vessels are not only of preventive importance but also favour the elimination of motor disorders in patients who suffered ischemic stroke.

[The efficacy of Neovir in the combined treatment of patients with operable tumors of the gastrointestinal tract]. / Effektivnost' Neovira v kompleksnom lechenii bol'nykh s operabel'nymi opukholiami zheludochno-kishechnogo trakta.

Under observation there were 32 patients with operable tumors of the gastro-intestinal tract. The average age of the patients was (64.8 +/- 7.5) years. Patients of the control group (18 patients were given the routine complex treatment. The main group (14 patients) were additionally given the interferonogenic immunomodulator "Neovir" which resulted in lower risk of the appearance of pyo-septic complications. It was confirmed by positive dynamics of the indices of cellular immunity, intensified production of proinflammatory cytokines and interferon-alpha.